Providers need to ‘be better’

“There was a time when we weren’t even talking about post-acute care; now we have a full post-acute care plan,’ says keynote speaker Dr. Patrick Cawley
Friday, September 23, 2016

CHARLESTON, S.C. – HME providers need to up their game if they want to keep up with changes in health care, a health system exec and a health insurance exec told attendees of the HME News Business Summit last week.

Prepare to be disrupted

Why? Disruptive change in health care—not just incremental change—is coming, Dr. Patrick Cawley, CEO of the Medical University of South Carolina, the 80th largest health system in the country, told attendees.

“The equation for value in health care (value=quality/cost) is becoming clearer and when that happens, the demand for value grows,” he said. “(That) is going to push us very hard.”

And when health systems get pushed, they push back, demanding better value, in turn, from their healthcare partners—particularly post-acute providers in this new world of readmission penalties, Cawley said.

“Getting patients home quicker will be the challenge of the next 10 to 15 years,” he said.

An HME provider is a successful partner to a health system when it measures outcomes, but not just readmission rates, Cawley said. He wants data that reflects the six domains of value in health care: safe, effective, efficient, equitable, patient-centered and timely.

“You need to come at me with (these) numbers,” he said.

An HME provider must also “understand where technology is going” related to telehealth, mobile health and app development.

“(If not), it makes me question whether or not you’re a good partner to work with,” he said.

One of the early signs that disruptive change is coming in health care, Cawley said: “There was a time when we weren’t even talking about post-acute care; now we have a full post-acute care plan.”

Be better, get paid better

Highmark, one of the 10 largest health insurers, is willing to pay more to post-acute care providers that create value in health care, Nick Stupakis, vice president of Home and Community Services, a Highmark Health company, told attendees.

“Paying everyone the same is not good enough anymore,” he said.

HCS, which manages Highmark Health’s network of post-acute care providers, has created a scorecard for skilled nursing facilities and home health agencies, and HME could be next. The scorecard measures metrics like length of stay and cost per episode, and uses a five-tiered methodology to assign providers reimbursement rates.

“If you do what you say, and you’re truly the best provider, we’re going to pay you differently,” he said.

HCS has created a team of “network performance managers” that score providers and review their results with them, Stupakis said.

“It’s a new approach to partnering with providers to help them be better,” he said.